I received my first chance to teach medical students when I was a third-year resident in psychiatry. The class was psychiatric interviewing, and I was ready. I reviewed the textbook. I studied the syllabus and its learning points. I brushed up on the DSM criteria. I arranged for real clients to be interviewed, as the course handbook suggests.
The first interview subject was staying on an inpatient unit. The student asked her why. She responded in brief, simple terms. She had been raped. Multiple men participated, holding the same gun to the same part of her head. She counted the seconds between violations—several hundred, usually. She reached a point where she was either going to fight back and be shot, or go insane. Instead, she pushed out a window and ran after she counted to 100. Maybe not “instead,” she noted, pointing to the walls.
The questions came quickly after she left. What are they supposed to do? To say to such a patient? How can a psychiatrist help her? Why would she speak at such length to those she knew so briefly? I had no prepared answer. So we talked about empathy, and mused about the trust that the title “doctor” engenders. About the awesome responsibility to gather an intimate knowledge of another person and use it to help them find a better way forward in life.
Osler said “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” Now I believe it.